As the most common benign neoplasm among American men, and a leading cause for urologic referral, benign prostatic hyperplasia (BPH) has a significant impact on health in the United States. Indeed, the direct medical costs of treating the urinary symptoms related to BPH exceed $1 billion per year, with another $1 billion in pharmaceutical costs. Despite these expenditures, little is known about the impact of the practice setting, primary-care versus urologist, on costs or outcomes related to care for men with BPH. In this K08 application titled, Primary-Care versus Urologist Management of Benign Prostatic Hyperplasia, we will determine the amount and sources of expenditures among men treated for BPH by primary-care physicians versus urologists, identify the factors leading to treatment by primary-care physicians versus urologists, and examine the costs and consequences of redistributing care from urologist to primary-care settings. We examine these topics by creating a cohort of patients newly treated for BPH from the 5% sample of Medicare claims data combined with Medicare Part D pharmacy claims. Advanced modeling techniques including geographic information system modeling, multilevel modeling, and cost-consequence decision analytic modeling will be used in the analysis of these themes. By determining the modifiable factors underlying the treatment of men with BPH in primary-care versus urologist settings, and the costs and outcomes of care in these settings, this study will make an important contribution to the improved delivery of care to men with BPH. During the three year period of support provided by this grant, Dr. Strope will continue his development towards becoming an independent, outstanding surgeon-scientist focussed on how variation in care impacts quality of care. The aims of the mentored research project described above provide the framework to pursue this training while addressing robust scientific and clinically relevant questions. Through the training provided by the K08 award, Dr. Strope's long term career goal of maturation into a successful, outstanding, independent surgeon-scientist will be fostered. For each section of the analysis plan, Dr. Strope has appropriate coursework and mentors to allow him to develop his independent research activity. From this project, he will develop preliminary data to be in a strong position to compete successfully for an independent R-level award, with a focus on practice patterns related to BPH in the primary care setting.